More than Weight: The Unhealthy Bias

by Janine Talis

Each person walks through life with his or her own ideas, perceptions and biases. For the most part, bias develops through influence from parents, teachers, friends, media or personal experiences. Over time, surrendering the idea that opinions may be based on incomplete evidence can be difficult to accept. Many biases are developed superficially, where appearances generate preconceived notions that are mistaken for complete knowledge of a person. Bias is not inherently misguided. However, there are some preconceptions that can be harmful, particularly in health care.

Several recent studies have revealed bias among doctors and medical students against overweight and obese patients. Such preconceptions include assuming patients are lazy or unlikely to follow treatment. Additionally, this research suggests that healthcare professionals are generally nicer to patients with a lower body mass index (BMI). In a study conducted at Johns Hopkins, researchers found that the standard of care did not vary significantly based on weight. However, upon reviewing transcripts of physician-patient discussion, they found that doctors were much more willing to provide encouragement and were overall more empathetic toward the patients with a healthy BMI. A study conducted by Wake Forest School of Medicine revealed that among medical students observed, 40 percent had a bias against the overweight that they were not previously aware of. Regardless of the origin, it is important for students to be aware of potential biases and learn how to manage them by being empathetic.

Empathy is an important factor for treatment success. Patients are more likely to retain their doctors or maintain treatment regimens if they believe their physicians care about their wellbeing. Patients can become frustrated with health care professionals who seem distracted by their weight. When a patient comes in with an issue unrelated to their weight, they would prefer doctors not become preoccupied with their body mass. This has led to the phenomenon of doctor shopping.

The phenomenon was described in a second Johns Hopkins study, which suggests that overweight and obese patients are more likely to switch primary care physicians several times more frequently than their lower weight counterparts. Overweight patients are also 85 percent more likely to visit an emergency room when compared to individuals of healthy weight, possibly because they are less likely to have regular primary care physicians. This increased likelihood to switch doctors could be due to an offhand negative comment or perhaps something outside of the doctor’s control such as the blood pressure cuff not fitting. When obese patients are reminded of the negative stereotypes they are faced with, they try to switch to more conscientious practitioners, which can be difficult to find.

At times patients may stop seeing doctors altogether. In a New York Times article, a woman so frustrated with physicians’ lack of considerate behavior regarding her weight stopped going even when she developed a breast tumor, seeking treatment only when it became advanced. Obese women are generally less likely to make regular appointments with their obstetrician/gynecologist, allowing illnesses such as cervical cancer to progress without early treatment.

Arguments about the dangers of obesity aside, treating patients less empathetically based on a predisposition can be hurtful, and is not likely to improve patient care. People, including physicians, go through life accumulating preconceptions and misperceptions, and a lack of empathy may arise consciously or otherwise based on these biases. Despite ingrained notions, confronting personal bias in an effort to exhibit respect and empathy toward all people should be a staple of practice for medical professionals.